title: Integration of family planning services into HIV care and treatment in Kenya: a cluster-randomized trial.
abstract: OBJECTIVE
  To determine whether integrating family planning services into HIV care is associated with increased use of more effective contraceptive methods (sterilization, intrauterine device, implant, injectable or oral contraceptives).
  
  
  METHODS
  Cluster-randomized trial.
  
  
  METHODS
  Eighteen public HIV clinics in Nyanza Province, Kenya.
  
  
  METHODS
  Women aged 18-45 years receiving care at participating HIV clinics; 5682 clinical encounters from baseline period (December 2009-February 2010) and 12,531 encounters from end-line period (July 2011-September 2011, 1 year after site training).
  
  
  METHODS
  Twelve sites were randomized to integrate family planning services into the HIV clinic, whereas six clinics were controls where clients desiring contraception were referred to family planning clinics at the same facility.
  
  
  METHODS
  Increase in use of more effective contraceptive methods between baseline and end-line periods. Pregnancy rates during the follow-up year (October 2010-September 2011) were also compared.
  
  
  RESULTS
  Women seen at integrated sites were significantly more likely to use more effective contraceptive methods at the end of the study [increased from 16.7 to 36.6% at integrated sites, compared to increase from 21.1 to 29.8% at controls; odds ratio (OR) 1.81, 95% confidence interval (CI) 1.24-2.63]. Condom use decreased non-significantly at intervention sites compared to controls (OR 0.64, 95% CI 0.35-1.19). No difference was observed in incident pregnancy in the first year after integration comparing intervention to control sites (incidence rate ratio 0.90; 95% CI 0.68-1.20).
  
  
  CONCLUSIONS
  Integration of family planning services into HIV care clinics increased use of more effective contraceptive methods with a non-significant reduction in condom use. Although no significant reduction in pregnancy incidence was observed during the study, 1 year may be too short a period of observation for this outcome.
authors.affiliation: aIbis Reproductive Health, Oakland, California bBixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA cKenya Medical Research Institute, Kisumu, Kenya dCenter for AIDS Prevention, Department of Medicine, University of California, San Francisco, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Newmann
authors.forename: Cinthia
authors.initials: C
authors.lastname: Blat
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Steinfeld
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D006302:Health Services Research; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult